AB1620 EMERGENCIES IN RHEUMATOLOGIC DISEASES: A REAL-LIFE EXPERIENCE FROM AN ITALIAN RHEUMATOLOGIC CENTRE
Authors: I. Cristiano, P. Triggianese, C. Minerba, A. D’antonio, C. Bonini, L. Fiannacca, A. Bergamini, M. S. Chimenti
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with rheumatic diseases (RDs) may present with severe and/or life-threatening conditions which might require hospitalization. RDs recognize a significant diagnostic delay because of variability of clinical features, often mimicking other systemic disorders. Accordingly, patients requiring hospitalization for new-onset emergencies should raise the suspicion of RDs also in absence of a known rheumatologic diagnosis. <h3>Objectives</h3> In this observational single-centre real-life study we analyse prevalence, distribution and management of RDs among patients hospitalized in a 3<sup>rd</sup> level Rheumatologic ward. <h3>Methods</h3> We collect demographic and clinical data from medical records of patients hospitalized in the Rheumatologic ward of "Tor Vergata" University Hospital in Rome (Italy), between 1<sup>st</sup> June 2021 to 31<sup>st</sup> December 2022. Patients are divided into two groups: known RDs at admission (Group 1) and new rheumatologic diagnoses (NRDs) at discharge (Group 2). Mean and standard deviation (SD) express normally distributed variables. Continuous variables are compared with T test, categorical variables by using Chi-square or Fisher's exact test. P&lt;0.05 values are considered statistically significant. <h3>Results</h3> The study cohort includes 179 patients (56% women) with a mean age at hospitalization of 62 ±16 y.o. Most of patients (68%) comes from Emergency Room (E.R.), and half of them (47%) has a defined diagnosis of RD at admission (Group 1). Patients admitted for suspected RD are 47 (26% of study population): among them, most cases (n=35, 74%) has NRD at discharge (Group 2). Comparing Group 1 (n=85, 63±14 y.o.) with Group 2 (n=35, 57±19 y.o.) we observe no difference in women prevalence (63% vs 51%) and referral from E.R. (58% vs 74%). Interestingly, diagnosis of rare rheumatological diseases (RRDs) occurs in a similar prevalence in Group 1 (n=37, 43%) and Group 2 (n=14, 40%). The most common reason for hospitalization in Group 1 is disease-flare (53%), followed by acute RD-related complications (27%) and treatment failure (20%). Patients from Group 2 are mainly hospitalized for new-onset severe joint pain (71%) while myalgia (11%), neuropathy (11%) and fever of unknow origin (6%) represent rare cases. In Group 2 a significantly higher proportion of severe inflammatory arthritis (P=0.008) and myositis (P&lt;0.05) is observed than Group 1. In the two groups we register a similar prevalence of systemic vasculitis, connective tissue diseases, systemic sclerosis, autoinflammatory diseases and primary antiphospholipid syndrome. A slightly higher proportion of patients is treated with steroids in Group 2 than in Group 1 (66% vs 55%). A quarter of patients receives csDMARDS in a similar prevalence; bDMARDs are used only in patients from Group 1 (7%). Rare cases from both groups are treated with intravenous immunoglobulin and prostanoids. In patients with non-rheumatological diseases at discharge (n=59) respiratory (51%) and renal disorders (34%) represent the main reasons for admission. Comparing them with patients with RD diagnosis (Group 1 + Group 2, n=120), a significantly higher prevalence of referral from E.R. results in the first group (P=0.002, Table I). <h3>Conclusion</h3> A relevant rate of RRDs occurs among patients requiring hospitalization in a similar prevalence between RDs and NRDs. Moreover, a new rheumatologic diagnosis is confirmed in most patients referring to E.R. in whom emergencies are suspected to be related to RDs. Accordingly, our preliminary data suggest that clinical suspicion for RDs and, thus, early referral to the Rheumatologic Unit should be adequately addressed also among patients from E.R. to improve the diagnostic delay in RD patients. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.